LEOPOLDS MANUEVER

DESCRIPTION

Leopold’s maneuver is a systematic method of observation and palpation which provide

information about the number of fetuses, the identity of presenting part , the fetal line and
attitude, the degree of descent into the pelvis and the location of the point of maximum impulse
of fetal heart rate (FHR) in relation to woman’s abdomen.

PURPOSES

1. Systematically observing and palpating the abdomen to:

Determine what is in the fundus
Evaluate the fetal back and extremities
Palpate the presenting part above the symphysis.

ASSESSMENT

Assess the health status of the mother and the fetus

Inspect the patient’s abdomen for the longest diameter and where the fetal
movement is apparent.
Assess for bladder distention

PLANNING

Prepare the needed materials

Explain the procedure to the patient and provide opportunity for the patient to verbalize
understanding of the procedure

Measure the fundic height;

Do this by placing one hand on each side of the abdomen and walk hands up the side of the
uterus, until you feel the uterus curve, hands should meet.
Take a tape measure and place the zero point at the symphysis pubis and measure to the top of
the fundus. The heights of the fundus correlates well with just stational age especially during the
earlier weeks of pregnancy.
Let's proceed to the leopold's maneuver
Expose only the part needed for the procedure, to provide clients privacy.
Warm hands, this is to prevent tensing of the abdominal muscles.

First maneuver;
Fundal grip

Stand in the foot of the client, facing her and place both hands on her abdomen

Rationale: This maneuver determines whether the fetal head or breech is in the fundus. Proper
positioning of hands ensure accurate findings.

Palpate the superior shape of the fundus, it determines shape, consistency and mobility.
When palpating a head feels more than a breech, a head is round and hard; the breech is less well
defined. A head moves independently of the body the breech moves only in conjunction with the
body.

2nd maneuver;
Umbilical grip

Face the client, place the palms in a lateral side of the abdomen.

Rationale: This maneuver locates the back of the fetus.

Palpate the side of the uterus, hold the left hand stationary on the left side of the uterus while the
right hand palpates the opposite sides of the uterus from top to bottom. And hold the right hand
steady and repeat palpation using the left hand on the left side

Rationale: this method is most successful to determine the direction the fetal back is facing. One
hand will feel a smooth, hard, resistant surface (the back), while on the opposite side, a number
of angular nodulations (the knees and the elbows of the fetus) will be felt.

3rd maneuver;
Pawlik's grip

Gently grasp the lower portion of the abdomen, just above the symphysis pubis between the
thumb and index finger. And try to press both fingers together, determine any movement in
whether the part is firm or soft.
Rationale: this maneuver determines the part of the fetus at the inlet of its mobility. If the
presenting part moves upward so an examiner's hand can be pressed together the presenting is
not engaged (not firmly settled into the pelvis). If the part is firm, it is the head; then it is a
breech.

4th maneuver;
Pelvic grip

facing the foot part of the client, place fingers of both sides of the uterus approximately 2 inches
above the inguinal ligaments, pressing downward and inward in the direction of the birth canal
allow fingers to be carried downward.

This maneuver determines fetal attitude and degree of fetal extension into the pelvis; it should be
done only if the fetus is in a cephalic presentation. Information about the infant's anteroposterior
position may also be gained from this final maneuver.

Next is the fetal heart rate

Determine the location, rate, and rhythm of the fetal heart. Warm the bell of the stethoscope to
avoid the stimulation of the contraction of the abdominal muscle. Auscultate the fetal heart rate
to the womans left lower abdominal quadrant with the fetal back is position on maternal left
vertex position, in breech presentations fetal heart rate is heard in the upper quadrant in the
maternal abdomen.

After taking the procedure, fix the client in a comfortable position. Document all the necessary
findings.

Including the fetal presentation, position, and if the presenting part is engaged or free-floating as
well as the fundic height and the fetal heart rate

The maneuvers consist of 4 distinct actions, each helping to determine the position of the fetus.
It is important because it helps to determine the presentation and position of the fetus which is in
conjunction with correct assessment of the shape of the maternal pelvis it can indicate whether
the delivery is going to be complicated or whether a cesarean section is neccesary.
 EVALUATION TOOL ON LEOPOLD’S MANEUVER

Name Date
Clinical Instructor                                                                     Group

Direction: Please rate the student’s level of competency on each expected skill’s using the scale
provided. (Please put a on the box)
 2- Done Independently (Student demonstrates excellent skills, exhibits competency
independently)
 1- Done with Assistance (Student demonstration excellent fair strength in demonstrating
skills with close supervisor)
 0- not done (student did not exhibit competency in demonstrating skills. Need
improvement)
Skill: Leopold’s Maneuver
Preparation score Comments
2 1 0
Prepare the client:
1. Provide for client privacy.
2. Ask the patient to empty her bladder or offer bed pan/ female
urinal if the client has distended bladder
3. Wash hands (preferably with warm water)
Assessment
4. Assist the client in a position with knees slightly flexed and the
head is resting on one pillow
5. Place small rolled cloth/ towel under the mother’s right or left
hip
First Maneuver:
6. Stand on the right side of the mother facing her for right-
handed examiner and on the left side for left-handed examiner
7. Place both hands on the mother’s abdomen
8. Palpate the superior part of the fundus, observing for
tenderness, shape, irregularities and mobility
Second Maneuver:
9. Place both hands on each side of the abdomen.  Using the
palmar surface of one hand, palpate the abdomen while the
 other hand is in a stationary supporting the opposite side of the.
10. Repeat the procedure using the other hand while the other is
stationary supporting.
11. Note for the smooth convex contour of the fetal back and
irregularities of the small parts
Third Maneuver:
12. With the dominant hand, grasp the lower pole of the uterus
between the thumb and fingers, pressing in slightly.
13. Determine any movement whether the presenting part is soft or
firm
Fourth Maneuver:
14. Turn to face the woman’s feet.
15. Using both hands, outline the presenting part with the palmar
surface of the fingertips by placing them approximately 2
inches above the inguinal ligament. Press downward and
inward while allowing the fingertips moving downward. Press
downward and inward while allowing the fingertips moving
downward.
16. Assist the client in a comfortable position
17. Wash hands and dispose used materials
18. Document findings accurately

COMPUTATION OF GRADES
STEP 1: Get the sum of all the points for the entire procedure
STEP 2: Use the formula below to get the final grade for the particular competency
Checklist

FORMULA: RAW SCORE / PERFECT SCORE X 75 + 25 = FINAL GRADE

Evaluated by:             Conforme:  

Signature over Printed Name   Signature over printed name

Clinical Instructor             Student

Date: ___________________               Date: ___________________

REMARKS:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________